The goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to understand the development of health communication competence in adolescents and young adults (AYAs) with type 1 diabetes (T1D) and evaluate associations among health communication, self-care, and health outcomes in this population. AYAs with T1D are at high risk for negative health outcomes, including poor glycemic control, increased chronic complications, and poor quality of life. The deterioration of glycemic control occurs in parallel with the assumption of independent self-care skills, including responsibility fo medical care. Effective communication between AYAs and health care providers may be a critical, yet understudied, contributor to self-care skills. The proposed longitudinal study plans o examine the development of health communication skills in 75 adolescents and young adults (ages 16-20) with T1D over an 18 month period and evaluate high- quality health communication as a predictor of diabetes self-care and health outcomes. The candidate's long term goal is to develop and implement innovative preventive interventions to best prepare AYAs with chronic illnesses and their families for transition to independent self-care. Specific short-term training goals proposed for this award include: 1) Develop expertise in the assessment and evaluation of health communication in AYAs; 2) Expand knowledge of pathophysiology of T1D; and 3) Gain advanced behavioral science competencies, including advanced data analyses, clinical trial design, and grant writing. The research and training experiences proposed within this 4-year K23 award will be conducted at Children's National Medical Center and Johns Hopkins University and are supported by an outstanding multidisciplinary team of mentors and advisors, including Dr. Randi Streisand (Primary Mentor), Dr. Pamela Hinds (Co-Mentor), and Dr. Kristin Riekert (Co-Mentor). This focused mentorship and training will position the candidate to become a successful independent investigator in behavioral diabetes research. Results from this study have the potential to greatly improve self-care skills and reduce negative health outcomes in AYAs with T1D. Equipping adolescents and young adults with skills to enhance health communication may hasten the development of vital self-advocacy skills needed for independent self-care and in the adult health care system and, thus, establish a lasting pattern of positive health interactions.